The healthcare sector faces rapid transformation from demographic changes, disease patterns and digital

innovations. Traditional training, focused on knowledge acquisition, struggles to prepare professionals for

dynamic roles. This study develops and evaluates competency-based training (CBT) modules using paramedics

at the Armed Forces Health Training Institute (INSAN) as a case study. A multi-stage design was employed,

integrating Training Needs Analysis, competency framework mapping, measurable learning outcomes and

standardized assessment tools. Findings reveal that CBT strengthens technical proficiency, decision-making and

adaptability, while addressing weaknesses in outdated curricula and unclear evaluation systems. Importantly,

Keywords: Training; Healthcare; Paramedics; Competency; Job Performance; CBT

The healthcare industry is currently experiencing rapid transformation, shaped by global demographic changes,

evolving disease patterns and disruptive technologies. Increasing reliance on artificial intelligence, robotic

surgery, telemedicine, simulation systems and digital health platforms is redefining how healthcare services are

delivered and how professionals are expected to perform (Mundinger & Mundinger, 2024; Kumar & Ali, 2024).

These shifts have heightened expectations for efficiency, precision and adaptability across healthcare

professions. At the same time, challenges such as workforce shortages, high turnover and professional burnout

are widely reported, especially among frontline providers such as paramedics, nurses and allied health

practitioners (World Health Organization [WHO], 2023). To address these pressures, healthcare organizations

In healthcare, where errors may be life-threatening, outcome-focused training is critical. CBT also aligns with

lifelong learning, enabling professionals to continuously update competencies in line with emerging medical

technologies and practices (Ajemba et al., 2024). The need is urgent for diploma-level paramedics, who require

to maintain strong clinical skills, rapid decision-making, and adaptability throughout their career development.

Yet, many training systems remain rigid, outdated and poorly aligned with career pathways (Dohan et al., 2017).

Without structured CBT modules, paramedics risk stagnation and demotivation, while continuous training

enhances resilience, job satisfaction and performance (Wang et al., 2022).

Despite recognition of training and career development, empirical studies on intervention-based competency

frameworks in healthcare remain scarce. Much of the literature emphasizes theoretical links between training

and job performance, while applied interventions showing measurable improvements are limited (Sendawula et

development literature and practically to institutional reforms, offering actionable insights for policymakers,

educators and healthcare leaders.

Armed Forces Health Training Institute (INSAN) is chosen as a case study in this article. As a healthcare

training institution, plays a vital role in preparing paramedics to meet industry demands. However, its current

training system remains largely traditional, emphasizing knowledge acquisition rather than competency-based

outcomes. This approach limits graduates’ adaptability to technological advances, evolving clinical practices

and career progression requirements. Diploma-level paramedics trained under these modules risk experiencing

skill stagnation, reduced motivation and declining performance over time. Therefore, addressing these gaps

through competency-based career training modules is critical to ensure paramedics remain competent,

Training Needs Analysis (TNA) is a critical first step in the development of CBT modules, as it provides a

practice (Ajemba et al., 2024; Wang et al., 2022).

Conducting a TNA at INSAN requires a multi-level assessment. First, it involves examining the weaknesses of

existing modules, such as outdated clinical content, limited integration of digital health tools and insufficient

emphasis on soft skills such as adaptability, problem-solving and teamwork. These gaps cannot be fully captured

through quantitative assessments alone. Hence, the incorporation of qualitative interviews with stakeholders,

including trainers, trainees, healthcare administrators, clinicians and medical logisticians, is crucial. A

qualitative approach in Training Needs Analysis (TNA) offers deep insight into practice gaps and contextual

challenges, especially when used with stakeholder interviews and thematic analysis frameworks (Marquez et

al., 2025). Such interviews provide in-depth insights into the practical shortcomings of the current modules and

highlight the evolving expectations of the healthcare workforce.

Table 1 highlights the findings that while clinical knowledge is emphasized, there is insufficient integration of

digital literacy, soft skills and structured career development. These weaknesses demonstrate the urgent need

for a CBT approach that aligns learning outcomes with workforce demands.

Moreover, this stakeholder-driven TNA will ensure that the training modules are not designed in isolation but

are grounded in the actual requirements of both the workforce and the industry. By systematically gathering

perspectives from multiple levels, INSAN can bridge the mismatch between training delivery and job

The development of CBT modules at INSAN requires a structured competency framework reflecting the Core

Areas of Study (CAOS) essential for the healthcare workforce (paramedic). Such frameworks are recognized

as critical for guiding professionals to acquire, demonstrate and sustain competencies aligned with evolving

clinical and administrative demands. Studies show that competency frameworks systematically link learning

outcomes with workforce expectations, supporting both immediate performance and long-term growth

(Mitchell et al., 2025). Similarly, learner-centered and competency-based clinical frameworks strengthen

capability by embedding adaptability, decision-making and reflective practice in training design (Henry et al.,

2025). Collectively, these findings highlight that well-structured frameworks are foundational for developing

healthcare modules that ensure sustainable and progressive career development.

Drawing from the thematic analysis of weaknesses in existing training modules, the Clinical Core Area of Study

domains ensure that clinical competencies address not only the technical aspects of care but also the professional

judgment and responsiveness necessary for excellence in healthcare delivery.

Similarly, the Administrative Core Area of Study (CAOS) also reflects the tri-domain framework of knowledge,

skills and abilities. Knowledge competencies include understanding healthcare policies, institutional procedures

and digital record-keeping standards essential for effective administration. The skills domain emphasizes

practical capacities such as accurate documentation, proficiency in digital health platforms, scheduling and

resource management to support organizational efficiency. In terms of ability, administrative competencies

highlight accountability, leadership potential and effective communication across departments. Embedding

these domains within administrative training ensures that healthcare professionals are not only operationally

efficient but also capable of contributing to institutional resilience and strategic development. By combining

The next step is the mapping of competencies to career progression pathways. Competencies should not only

define entry-level expectations but also outline progressive mastery aligned with promotions, specialization and

leadership roles. For example, clinical competencies may begin with basic emergency response at the diploma

training modules contribute not only to immediate job performance but also to sustainable career growth,

Table 3 demonstrates that by linking clinical and administrative competencies to task and contextual

performance, it will reinforce the reliability of the CBT module in producing workforce-ready paramedics who

can perform effectively in real healthcare settings.

Developing module’s content is vital for translating measurable learning outcomes into structured learning

experiences that enhance workforce competencies. Content must be carefully designed to align outcomes with

appropriate teaching methods. Clinical performance, such as patient assessments or equipment use, is best

supported by simulation-based training, which replicates high-pressure environments, refines technical skills,

provides feedback and builds confidence without compromising safety (Ferreira et al., 2025). Case studies foster

cognitive and problem-solving skills by requiring evidence-based decisions in real-world contexts. Practice-

competencies progress from basic clinical and administrative tasks at the junior supervisory to senior managerial

level. Therefore, a step-by-step cascade teaching plan is designed to scaffold training content across four

modules to aligned with the career stage. This progressive teaching model supports role-specific development,

prepares trainees for leadership, and aligns training with structured career development pathways and

institutional expectations (Devi et al., 2025

In addition, module content must embed lifelong learning and reflective practice as integral elements. Lifelong

learning encourages professionals to view competency as a continuous process, promoting engagement with

new knowledge, skills and emerging technologies beyond initial training (Björk et al., 2025). Reflective

practice, facilitated through learning journals, feedback discussions, or peer evaluations, enables learners to

critically analyze their performance, recognize strengths and weaknesses and develop strategies for ongoing

comprehensive, combining both formative and summative approaches. Reflective elements are incorporated

and later assessed through formative assessment. Summative assessments, on the other hand, serve as

benchmarks for competence at the end of training. Together, both methods create a balanced system that

supports learning and accountability (Dube et al., 2025).

To ensure reliability and objectivity, the use of standardized instruments is critical. Tools such as the Individual

Work Performance Questionnaire (IWPQ) by Koopmans, (2015) allow for systematic measurement of task

performance, contextual performance and counterproductive behaviors, providing a validated framework for

evaluating workplace effectiveness. Similarly, CBT tests assess technical proficiency, problem-solving ability

and digital literacy in measurable ways. By embedding such instruments, evaluations move beyond subjective

impressions to evidence-based judgments of performance. A questionnaire was also developed from the content

demands and evolving healthcare practices.

Table 4 Assessment framework

design to practical application. The first critical step in implementation is piloting the modules with paramedic

trainees. Piloting allows training designers to evaluate the feasibility, relevance and effectiveness of the module

content under real learning conditions (Biddle Jr et al., 2021). Through this process, facilitators can observe

how trainees interact with learning activities such as simulations, case studies and digital tools, while identifying

challenges that may hinder the achievement of intended outcomes.

Early piloting also provides an opportunity to test the alignment of training content with measurable learning

outcomes and job performance indicators. A pilot validation involving 90 paramedic trainees was conducted to

evaluate the feasibility and impact of the module. Using a pre- and post Paramedic Competency Test Self-

Assessment Tool and the Individual Work Performance Questionnaire (Koopmans, 2015), initial results

indicated an increase in paramedic’s competency and job performance post trainings.

demands of the healthcare industry.

Monitoring and continuous improvement are essential to ensure that CBT modules remain effective, relevant,

and sustainable in the long term. The primary objective of monitoring is to evaluate effectiveness through

performance outcomes and learner feedback. Performance data such as assessment results, workplace

evaluations, and promotion success rates will provide quantitative evidence of whether trainees are meeting

competency standards. Simultaneously, learner feedback offers qualitative insights into the clarity, applicability

Beyond immediate outcomes, it is equally important to review the alignment of modules with evolving

healthcare needs. The healthcare industry is dynamic, shaped by new technologies, regulatory changes, and

shifting patient demographics. Training modules must therefore be periodically reviewed to ensure that

competencies in areas such as digital literacy, simulation-based practice and evidence-based decision-making

Finally, continuous improvement requires updating modules for sustainability and scalability. This involves

incorporating innovations, addressing identified gaps and ensuring that training resources can be scaled across

different cohorts or institutions (Dunne et al., 2022; Hao et al., 2021). A structured monitoring and review cycle

ensures that modules do not become outdated but instead evolve with the industry. This approach guarantees

that paramedic trainees remain competent, adaptable and prepared for future challenges in healthcare

directly with career progression, fostering both professional growth and retention. However, resource intensity

of redesigning curricula, assessing competencies reliably and ensuring stakeholder buy-in will become

weakness factors.

Unlike conventional training models used in many national healthcare institutions, which rely on fixed curricula

and time-based progression, the INSAN CBT model integrates career-linked competency mapping. Comparable

to frameworks used by the UK National Health Service (NHS) and Singapore’s Workforce Skills Qualifications

(WSQ), this model emphasizes progressive mastery, adaptability, and reflective learning, offering a scalable

and locally contextualized alternative. For future improvement, it is suggested that institutions adopt hybrid

approaches, integrating digital tools, simulations, and continuous feedback loops to enhance the scalability and

sustainability of the training modules. This integration ensures healthcare professionals are not only clinically

modules. However, limitations include researcher bias, subjectivity in coding and the resource-intensive nature

of data collection and analysis (Nowell et al., 2017). To improve, future TNAs should integrate mixed-method

approaches, employ qualitative software for consistency and strengthen trustworthiness through peer debriefing

and member checking. Such practices ensure that qualitative insights remain credible, scalable and impactful in

shaping healthcare workforce training.

The content of training modules was used alongside paramedic’s job descriptions in designing competency

assessment methods. Job description will define the skills, knowledge and abilities required for successful job

performance, ensuring that the competencies gained will align with job expectations (Skorobogatova, 2023).

The strength of this approach lies in its relevance and practicality, as assessments reflect actual job performance

indicators such as patient assessment, documentation accuracy and adaptability. However, over-reliance on

that continuously updates job descriptions and module content based on evolving technologies, regulatory

standards and stakeholder feedback, ensuring long-term validity and workforce readiness.

making and clinical precision, while micro-credentialing offers modular recognition of specific skills, fostering

lifelong and flexible learning pathways. Reflective learning, through journals and feedback sessions, cultivates

self-awareness and continuous improvement among trainees. Collectively, these innovations enhance

scalability, personalization and sustainability within the INSAN’s CBT module, ensuring that paramedics

A key limitation of this research is its reliance on a single case study context (INSAN), which restricts the

generalizability of findings across diverse healthcare systems. While the CBT modules were systematically

applicability. Furthermore, most insights were derived from thematic analysis and stakeholder input, which may

introduce subjectivity and bias despite efforts to ensure rigor. Future studies should incorporate larger samples,

quantitative validation, and longitudinal tracking to strengthen external validity and capture long-term

workforce outcomes.

and adaptability to emerging technologies such as AI and telehealth. Longitudinal and comparative studies

across institutions can reveal best practices and scalability, while mixed-method approaches enrich both

quantitative outcomes and experiential insights. Cross-national analyses are also essential to capture cultural

and systemic variations. These directions will provide stronger evidence for reforms, ensuring training modules

remain relevant, dynamic and aligned with global healthcare demands.

Beyond its institutional relevance, this study introduces an innovative, digitally integrated and career-linked

CBT model adaptable across healthcare contexts. Its structured mapping and validated outcomes provide a

replicable foundation for future global training reform. By integrating Training Needs Analysis, structured

competency frameworks, measurable learning outcomes and robust assessment methods, the study

demonstrates how CBT modules enhance job performance, motivation, and long-term career sustainability. The